超声联合乳腺X线摄影及PR、Her-2预测高级别与中低级别乳腺导管原位癌的价值

Prognostic value of ultrasound combined with mammography and PR and HER-2 status in high-grade and middle-low-grade ductal carcinoma in situ of the breast

目的探讨超声、乳腺X线影像学特征及孕激素受体(PR)、人表皮生长因子-2(Her-2)对高级别与中低级别乳腺导管原位癌(DCIS)的预测价值。方法回顾性分析山西省肿瘤医院2015年1月至2020年12月经手术病理证实的196例DCIS患者,术前均行超声及乳腺X线检查且病理资料完整。根据术后病理结果将其分为高级别DCIS组80例和中低级别DCIS组116例。应用单因素分析方法比较2组患者影像表现及免疫组化的差异,将差异有统计学意义的因素纳入多因素Logistic回归分析,分析高级别与中低级别DCIS的独立预测因素。结果将单因素分析有统计学意义的超声表现为肿块、乳腺X线为微钙化、雌激素受体(ER)、PR及Her-2纳入二元Logistic回归进行多因素分析。结果表明,超声表现为肿块(OR=0.248,95%CI:0.109~0.562)、PR受体阳性(OR=0.230,95%CI:0.057~0.931)是中低级别DCIS的独立预测因素。乳腺X线表现为微钙化(OR=4.048,95%CI:1.736~9.440)、Her-2阳性(OR=6.160,95%CI:2.149~17.655)是高级别DCIS的独立预测因素。结论术前影像学检查及免疫组化PR、Her-2测定对DCIS的预测及DCIS患者的管理及治疗具有一定临床价值。

Objective To assess the predictive value of ultrasonography,mammography,and progesterone receptor(PR)and human epidermal growth factor 2(HER-2)status for high-grade and middle-low-grade ductal carcinoma in situ(DCIS)of the breast.Methods A retrospective analysis was performed on 196 patients with breast DCIS confirmed by surgical pathology from January 2015 to December 2020 at Shanxi Tumor Hospital.All patients were examined by ultrasonography and mammography before operation,and had complete pathological data.According to postoperative pathological results,the patients were divided into a high-grade DCIS group(n=80)and a middle-low-grade DCIS group(n=116).Univariate analysis was used to compare the differences in imaging and immunohistochemical features of patients in the two groups.Factors with statistically significant differences in the univariate analysis were included in multivariate Logistic regression analysis to analyze the independent predictors of high-grade and middle-low-grade DCIS.Results The statistically significant parameters identified in the univariate analysis,such as mass on ultrasound,microcalcification on mammography,and estrogen receptor(ER),PR,and HER-2 status,were included in binary logistic regression for multivariate analysis.The results showed that mass(odds ratio[OR]=0.248,95%confidence interval[CI]:0.109~0.562)and PR positivity(OR=0.230,95%CI:0.057~0.931)were independent predictor of middle-low-grade DCIS.Microcalcification(OR=4.048,95%CI:1.736~9.440)and HER-2 positivity(OR=6.160,95%CI:2.149~17.655)were identified to be independent predictor of high-grade DCIS.Conclusions Preoperative imaging examination and immunohistochemical determination of PR and HER-2 status have appreciated clinical value for the prediction of DCIS and the management and treatment of DCIS patients.